home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Complete Home & Office Legal Guide
/
Complete Home and Office Legal Guide (Chestnut) (1993).ISO
/
ex
/
fib
/
pe
/
5580.ws
(
.txt
)
< prev
next >
Wrap
WordStar Document
|
1993-08-01
|
2KB
|
55 lines
DECLARATION IN CONFORMANCE WITH MISSOURI STATUTES 459.015
I have the primary right to make my own decisions concerning
treatment that might unduly prolong the dying process. By this
declaration I express to my physician, family and friends my
intent. If I should have a terminal condition it is my desire that
my dying not be prolonged by administration of death-prolonging
procedures. If my condition is terminal and I am unable to
participate in decisions regarding my medical treatment, I direct
that my attending physician to withhold or withdraw medical
procedures that merely prolong the dying process and are not
necessary to my comfort or to alleviate pain. It is not my intent
to authorize affirmative or deliberate acts or omissions to
shorten my life rather only to permit the natural process of
dying.
Signed this ____________________ day of ________________
____________________.
________________________________________________________________
Signature- __________________
City of residence: __________
County of residence: ________
State of residence: _________
The declarant is known to me, is eighteen years of age or older,
of sound mind and voluntarily signed this document in my presence.
________________________________________________________________
Witness
Address:
________________________________________________________________
Witness
Address: